Adolescent Champion - Staff Spark 5: Adolescent Centered Care Supplies: Projector, laptop, worksheets for case scenarios Time 5 min. Content Intro/Hook Title Slide For this Staff Spark, we’ll be applying some of the concepts about culturally appropriate care from last month’s Spark to our specific population, adolescents (better known as teenagers), and we’ll be thinking about what makes it challenging to be sensitive to their needs. Slide change – Case Scenario: Shayla To help us think about what this means in our day to day life, here’s a scenario that may seem familiar. You work at the front desk. 16 year-old Shayla is 10 minutes late for her appointment, and she comes up to the front desk to check in. She does not look up at you, but instead, she stands at the desk and appears to be texting. In an upbeat voice, you say, “Hello! Do you have an appointment?” She continues to look at her phone, frowns, and keeps texting while you wait. Finally, she looks up and says, “What?” We’ll come back to this scenario in a minute, but for now, consider what your gut response is to this situation. Slide change – definitions Like we discussed last month, on the left is the definition of cultural appropriateness. On the right side is the definition of adolescent centered care. “Culturally appropriate services are health care services that are respectful of and responsive to cultural needs (of patients).” “Adolescent Centered Care focuses on being respectful of and responsive to the developmental needs of adolescents.” What are some of the ways we’re trying to be respectful of the developmental needs of adolescents? [You may choose to have staff respond, or mention any of these below.] We’re trying to engage teens in guiding clinical decisions that relate to them. You may have seen teens visiting the health center over the summer, as we’ve been reaching out to teens to help us make the center welcoming. Because the right to confidentiality is an important need for adolescents, we’ve posted Adolescent Confidentiality Rights posters in exam rooms, and done Sparks on Confidentiality. We’ve added new health education materials chosen by a teen advisory council. We avoid using medical jargon to explain things. We do risk assessments (RAAPS) with more teen patients, so providers can learn more about the needs of individual teen patients and address their risky behaviors. [Add any others you want to.] In today’s Spark, we’re talking about teens’ developmental characteristics specifically, and through scenarios, we’ll think about how we can be respectful of their needs. 3 min. Slide change – Here’s a quote about the stage of adolescence. [Read quote] “Adolescence has qualities that are essential for the individual to go through, that are a part of the way the brain is changing.” - Daniel J. Siegel Even if we know that “teens will be teens,” and it’s an important phase in life, it can still be challenging to work with them. Some people love working with teens, some don’t – either way, understanding what’s going on for them can help us be respectful and give them the care they need so they’ll keep coming back to us. Key Concepts Slide change – Adolescent Brain Development In the past few years, researchers have learned much more about how the adolescent brain develops. The last Adolescent Champion - Staff Spark 5: Adolescent Centered Care region of the brain to develop doesn’t fully mature until the mid-20s. This is the part that controls complex decision-making, judgment, and fully understanding consequences. At the same time, the need for peer acceptance is at its peak, and many teens seek excitement through risk behaviors – and don’t always have an accurate perception of the consequences of the risk behaviors (like using alcohol and other drugs and having unprotected sex). Also, most teens are focused more on themselves and their needs than they are others. Slide change – Developmentally appropriate behaviors Often, when adults interact with teens, we see negative behaviors that can be challenging or annoying, and we forget that their behaviors are often developmentally appropriate. When a toddler has a tantrum, it might be easier for us to keep our frustration in check by reminding ourselves that there are often clear reasons for their tantrum: they’re frustrated because they can’t use words to express that they’re tired, hungry, etc. Our first reaction to a toddler’s tantrum might be irritation. But usually, our adult brain kicks in and says something like, “Take a deep breath. He’s hungry and missed his nap today and this will pass. I need to get him a snack and ride this out.” So how can we take a pause when teens challenge us, and give them the patience and respect that they need? 4 min. Slide change – One way to look at it is: teens probably won’t change their behavior; how will we change ours? It’s up to us as adults to help them along the way, and it’s what we can do to be truly patient-centered. Application Slide change – Photo of teens Pass out worksheets – Case Scenarios: Challenging Adolescent Interactions Let’s look at some scenarios to think more specifically about how we can do this. Here’s a sheet with case scenarios of teens. Turn to the person near you, and in groups of two or three, read through all the scenarios and then together, pick one scenario that applies most to the work you do. [You may opt to do this as a group.] Slide change – Questions Once you pick your scenario, respond to the following questions. Instead of figuring out how to handle the situation, let’s focus on how we’re feeling and thinking. 1. What is your gut feeling? 2. What negative assumptions do you think adults might make about this teen’s behavior? 3. What alternative explanations might there be, or what developmental characteristic might be at work? (This part might help adults have more patience and respect for where the teen is coming from.) 1 min. For example, let’s consider Shayla’s scenario again. She was late, and then was texting while the receptionist was asking her if she had an appointment. Question 1 – Gut feeling – [If time, ask staff, or just say:] This might make someone annoyed or mad. Question 2 – Negative assumptions - Sometimes, without consciously thinking about it, we create a quick story in our heads about why someone is behaving a certain way. In this case, we might think to ourselves, “I bet she’s texting a friend about something unimportant, and she’s rude to ignore me.” Question 3 – Here’s where we need to rewrite the story, and imagine other possible reasons Shayla is behaving as she is. One possibility is that she was late because her father’s car didn’t start, so she had to take a bus. When she walked to the front desk, she frowned when she got a text from her mother saying that she needed to get home as soon as possible to watch her younger brother. Developmentally, she might be tuned in to her own needs more than the receptionist’s, so she is distracted by her text and doesn’t reply right away. Now, this situation still might be frustrating – and the text could also really have been from a friend about something trivial – but it can help us give teens the benefit of the doubt, and not let our gut feeling control our reaction to the teen. Take 1 minute to respond to your scenario.[1 min. discussion in pairs; ask for 1-2 pairs to share if time.] Sparkler - To keep our theme of Adolescent Centered Care on our minds this month, we’ll post case scenarios that will help us look at our assumptions. Try to notice when you have judgments when interacting with teens.